A COMMON TREK TO VALUE

Transcription

1 49 LEADERSHIP FALL 2014 A COMMON TREK TO VALUE While healthcare leaders need to tailor their value-based business approach to their organizations unique characteristics and market situations, they can follow a common map to navigate toward higher quality and lower costs. As part of its Value Project research,* HFMA worked with a diverse group of 35 hospitals and health systems to identify and understand four organizational capabilities that providers can cultivate as the marketplace continues to shift to reward value (or quality price to the purchaser): People and culture: The ability to collaborate, effectively manage change, communicate a value message, and create accountability to value-driven goals Business intelligence: The ability to collect, analyze, and connect quality and financial data to support organizational decision making Performance improvement: The ability to eliminate clinical variation, unsafe practices, and waste Contract and risk management: The ability to predict and manage different forms of patient-related risk under different payment methodologies Turn the page to see specific strategies and tactics that organizations can adopt to navigate these four summits of value transformation. * For more on HFMA s Value Project, visit hfma.org/valueproject.

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3 Complete Confidence 340B Complete : The proven way to expand access to quality care A solid foundation of trust between your organization and your 340B partner is crucial to your success in this ever-changing environment. Walgreens 340B Complete is the ONLY 340B Contract Pharmacy single-vendor, end-to-end solution that combines convenient local pharmacy care, compliance-enabling support and turnkey administration management. As the Contract Pharmacy Network market leader, Walgreens 340B Complete provides Convenient access to enhanced patient care Opportunities for drug cost savings Robust technology and analytics Proven compliance and reliability Efficient and inexpensive implementation Support that has led to impressive HRSA audit success rates for its contracted Covered Entities Walgreens 340B Complete alleviates the burden inherent in running a 340B program. Further your organization s mission with Walgreens 340B Complete. Walgreens 340B Complete is the only 340B program in the country to earn an HFMA Peer Review designation. *HFMA staff and volunteers determined that this product has met specific criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this product. Visit 340BComplete.com to learn more Walgreen Co. All rights reserved. WGPS Source: Based on a compilation of audit and search results from the Health Resources and Services Administration Office of Pharmacy Affairs from 2012 and 2013.

4 THE MOUNTAIN RANGE OF HEALTHCARE VALUE While every healthcare organization must travel down its own path to value, many cross four major summits on the way to the Triple Aim as defined by the Institute for Healthcare Improvement: improving the patient experience, advancing population health, and lowering the total cost of care. Summit PEOPLE & CULTURE Strategically Transition Staff Assess future staffing and skill needs Add staff strategically Develop a Flexible Culture Articulate the organization s value message Educate and engage all staff Encourage risk-taking and innovation Strengthen Governing Board Adjust composition to ensure needed expertise Educate leaders on changing marketplace Improve decision-making processes Integrate and Incentivize Physicians Elevate physicians into executive positions Educate and develop physician leaders Tie incentives to quality/cost performance Align Executive Leaders Translate strategic plans into common goals Monitor key metrics and tie to incentives Adjust resources, as needed, to ensure success Determine Strategy for Achieving Value Evaluate needs of key patient populations Assess mergers, acquisitions, and affiliations Optimize cost structure while ensuring quality The four summits, as well as the steps listed on each summit, are not necessarily in sequential order. The infographic is based, in part, on The Value Journey: Organizational Road Maps for Value-Driven Health Care, an HFMA Value Project Phase 2 report, which provides specific advice on improving value for different types of hospitals and health systems, including academic medical centers and rural hospitals. Access the detailed report at hfma.org/valueproject.

5 Summit BUSINESS INTELLIGENCE ACHIEVING THE TRIPLE AIM IMPROVE PATIENT OUTCOMES/EXPERIENCE After slashing MRSA infections, Nash Health Care System is striving for zero infections. MRSA infections DECREASED 84% in four years % years Track Performance Track outcome and process metrics Develop population-level reporting capabilities Improve Costing Capabilities Move from identifying trends to pinpointing specific costs Understand costs across settings and time Develop per-member, per-month costing capabilities Invest in Data Warehouse and Analytics Review data governance (e.g., data definitions) Integrate clinical and financial data Invest in decision-support capabilities Invest in Clinical IT Implement EHRs in all settings Establish alerts Establish disease registries Develop capability to exchange data and information

6 ACHIEVING THE TRIPLE AIM Summit PERFORMANCE IMPROVEMENT IMPROVE POPULATION HEALTH By partnering with parents, Boston Children s Hospital is keeping children with asthma out of the ED and in school. 41 percent REDUCTION in missed school days Engage Patients and Community Create transparency around performance Engage patients through shared decision making and other tactics Strengthen ties to the community Partner for Population Health Management Measure, expand, and/or leverage primary care access Assess and right-size the scope of services Partner strategically for population management capabilities Adopt Evidence-Based Medicine Begin with patient safety concerns Adopt standardized orders and protocols Manage high-risk and chronic care patients Develop Process Improvement Capabilities Identify methodologies (e.g., Lean) Establish cross-functional team/department to guide efforts Use clinical/cost data to prioritize opportunities Expand efforts across departments and continuum

7 Summit CONTRACT + RISK MANAGEMENT ACHIEVING THE TRIPLE AIM REDUCE THE TOTAL COST OF CARE Since 2009, Regions Hospital in St. Paul, Minn., has cut medical costs > $4.1 million by reducing readmissions % readmission rate Pursue Value-Based Payment Contracts Partner with payers Experiment with shared savings, bundled payment, and other approaches Prepare for higher levels of financial risk Mitigate Insurance Risks Forecast utilization and cost patterns among patient sub-populations Identify successful interventions for high-risk patients that hold down costs Negotiate risk corridors with payers to cap potential losses under risk-based contracts Understand Your Costs Move from identifying trends to pinpointing specific costs Understand costs across settings and time Develop per-member, per-month costing capabilities Plan for Value-Based Initiatives Develop rolling calendar of cost-containment plans Update cash flow models and capital budgets Quantify and allocate initiatives

8 52 LEADERSHIP HFMA.ORG/LEADERSHIP MINI CASE STUDIES: VALUE TRANSFORMATION These brief examples illustrate how some of the 35 hospitals and health systems involved in HFMA s Value Project are tackling the four summits of value. PEOPLE AND CULTURE Winona Health organized its key strategic goals around the Triple Aim, emphasizing patient satisfaction, quality and cost indictors, and community health. The health system has attached performance metrics to each component of its strategic plan, the results of which are broadly communicated. Managers regularly report their progress on key measures, and share with senior leadership ideas to improve performance on activities that are off track from the plan. Senior leaders meet on a regular basis to review measured performance and to shift resources as necessary to ensure success on the organization s highest priority initiatives. Other leading organizations are tying physician and staff incentives to performance on the strategic plan, either at the outcomes level (e.g., patient satisfaction, operating margin) or in relation to key initiatives. For example, Nebraska Methodist Health System uses dashboards to assess individual physician adherence to clinical protocols. System. We thought we d get major pushback from the surgeons, says Art Boudreaux, MD, chief of staff, UAB Medicine. However, what they found was that if they are relieved of this duty, it gives them more time to focus on their surgical operations. Now, the surgeons are totally on board. Organizations are also pursuing innovative partnerships with other providers, particularly those that are aiming to build population management capabilities more quickly. Longmont United Hospital in Colorado has formed a coalition with several neighboring facilities and medical groups to serve the needs of local self-insured school districts, with the hope of expanding to include other self-funded employers. Another key partner is patients and their families. Shared decision making is a key patient engagement initiative at Partners HealthCare that leaders believe will improve quality, satisfaction, and cost structure. Shared decision making begins by educating the patient about the pros and cons of each treatment option typically through decision aids that include videos, written materials, and/or testimonials from patients about their treatment experiences. The patient is then ready to have an educated and thoughtful conversation with their provider. BUSINESS INTELLIGENCE Nebraska Methodist also mines data to compare physicians performance on metrics related to diabetes, hypertension, and other diseases and conditions. The goal is to reduce clinical variation. Many Value Project organizations report ambiguities related to data governance that is, who defines the data, determines which data flow into the warehouse and decision support systems, and continually maintains the data to ensure they are clean, complete, and accurate. University of Alabama at Birmingham is putting a cross-functional oversight committee into place to tackle this function related to its new decision-support system. PERFORMANCE IMPROVEMENT To secure physician buy-in for process improvement activities, many providers first pursue projects in which clinical leaders have expressed interest. An example is a perioperative surgical home initiative at UAB Health CONTRACTING AND RISK MANAGEMENT Bon Secours Health System is relatively advanced in its ability to quantify financial impacts of care delivery changes. Its approach is to determine a focus area, such as fixed costs, and apply consistent, systemwide methodologies and principles to determine the financial impact of its efforts. Resources from financial planning assist clinical initiative leaders in this process. Some organizations have established partnerships with payers in which insurance carriers help pay for value improvement initiatives, such as the infrastructure costs related to establishing patient-centered medical homes (PCMH). For example, Pennsylvania-based Holy Spirit Health System has partnered with Highmark Blue Cross to pilot PCMHs at two of its primary care sites. Holy Spirit received funding to hire a PCMH development nurse and transitions development nurse. Highmark pays a per-patient visit fee, with additional reimbursement available to sites that obtain PCMH certification.